Causes of death and mortality crossovers by race

Abstract

The phenomenon of “mortality crossovers,” the intersection of age curves of mortality at older ages, has been observed in comparisons of various populations for some time. Some researchers have argued that crossovers are an artifact of deficient reporting of age that is greater for some populations than others. Other researchers attribute crossovers to selective processes by age that vary by group. We use mortality data from the National Center for Health Statistics for the U.S. at ages 55 and over, supplemented by comparable data from matched records of the National Health Interview Survey and National Death Index, to reexamine causes of death linked to mortality crossovers for Whites and Blacks in the U.S. Findings portray a more elaborate set of influences of causes of death than has been discovered heretofore; however, the major finding is that the mortality crossover for Whites and Blacks in the U. S. is real and, although observed for several causes of death, operates principally through varying trajectories of heart disease mortality.     

Another look at mortality crossovers

Abstract

Considerable debate still ensues on whether or not the so‐called “mortality crossover,” the intersection of age curves of mortality at the older ages, is artifactual or real. One school of thought argues that it is a function of misreporting of ages, greater for one population than another. The other school of thought counters that it persists apart from age misreporting and is due to selective frailty processes as age increases. An historical review of the debate is reported, after which an attempt at a balanced conclusion is offered.     

Temporal trends in net and crude probability of death from cancer and other causes in the Australian population, 1984–2013

BackgroundWhile net probabilities of death in the relative survival framework ignore competing causes of death, crude probabilities allow estimation of the real risk of cancer deaths. This study quantifies temporal trends in net and crude probabilities of death.MethodsAustralian population-based cohort of 2,015,903 people aged 15-89 years, diagnosed with a single primary invasive cancer from 1984 to 2013 with mortality follow-up to 31 December 2014. Survival was analyzed with the cohort method. Flexible parametric relative survival models were used to estimate both probability measures by diagnosis year for all cancers and selected leading sites.ResultsFor each site, excess mortality rates reduced over time, especially for prostate cancer. While both the 10-year net and crude probability of cancer deaths decreased over time, specific patterns varied. For example, the crude probability of lung cancer deaths for males aged 50 years decreased from 0.90 (1984) to 0.79 (2013); whereas the corresponding probabilities for kidney cancer were 0.64 and 0.18 respectively. Patterns for crude probabilities of competing deaths were relatively constant. Although for younger patients, both net and crude measures were similar, crude probability of competing deaths increased with age, hence for older ages net and crude measures were different except for lung and pancreas cancers.ConclusionsThe observed reductions in probabilities of death over three decades for Australian cancer patients are encouraging. However, this study also highlights the ongoing mortality burden following a cancer diagnosis, and the need for continuing efforts to improve cancer prevention, diagnosis and treatment.     

Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero,One and Five in India: A Decomposition Analysis

Objectives

Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover.

Methods

We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981–2009 for 16 Indian states by sex (comprising of India’s 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover.

Findings

India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women).

Conclusions

For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1–59 months in high child mortality areas can help India to attain this crossover early.     

Physiological changes in successive pregnancies and birth‐order effects

Abstract

An analysis of mortality rates documents that the well‐established female advantage in mortality continues to increase. Data from the U.S. census show that the sex differential in mortality has increased from 1.69 in 1963 to 1.82 in 1976. The age groups which show the most pronounced changes are youth (15–24), young adults (25–34), and old persons (75–84). Following Enterline (1961), we assess the major causes of death within each of these age groups in terms of their relative contributions to changing sex ratios. The major factors among young persons, apart from declining maternal mortality, are found to involve violent deaths, especially traffic accidents and suicide. Among old persons, death rates in general have declined, but advances in medical technology appear to have been more beneficial for older women than for older men, supporting the hypothesis of a biological superiority among women. However, death rates for malignant neoplasms have increased for older women as well as older men, suggesting that changing life styles may eventually have an impact on female mortality. The data suggest a need for additional research concerning the increase in violent deaths among young women and the potential increase in cancer deaths among older women.     

Alcohol consumption and mortality: modelling risks for men and women at different ages

ObjectiveTo estimate the relation between alcohol consumption and risk of death, the level of alcohol consumption at which risk is least, and how these vary with age and sex.DesignAnalysis using published systematic reviews and population data.SettingEngland and Wales in 1997.ResultsA direct dose-response relation exists between alcohol consumption and risk of death in women aged 16-54 and in men aged 16-34. At older ages the relation is U shaped. The level at which the risk is lowest increases with age, reaching 3 units a week in women aged over 65 and 8 units a week in men aged over 65. The level at which the risk is increased by 5% above this minimum is 8 units a week in women aged 16-24 and 5 units a week in men aged 16-24, increasing to 20 and 34 units a week in women and men aged over 65, respectively.ConclusionsSubstantially increased risks of all cause mortality can occur even in people drinking lower than recommended limits, and especially among younger people.

What is already known on this topic

Non-drinkers and heavy drinkers have higher all cause mortality rates than light drinkers—the U shaped curveThe precise shape and location of the U are likely to depend on age and sex, but this has not been quantified

What this study adds

The level of alcohol consumption that carries the lowest mortality ranges from 0 in men and women aged under 35 to 3 units a week in women aged over 65 and 8 units a week in men aged over 65The level of alcohol consumption that carries a 5% increase in mortality increases with age from 8 to 20 units a week in women and from 5 to 34 units a week in menOur calculations were for England and Wales in 1997: nadirs are likely to be lower in the future and in countries with less ischaemic heart disease     

Density and age-specific mortality

Age-specific mortality rates decelerate at older ages in laboratory populations in the MedflyCeratitis capitata. This has been interpreted by Careyet al. (1992) to reflect a slowing of the aging process, but might also be explained by declining adult density. Here it is argued that the density explanation, as presented by Graves and Mueller (1993), is unpersuasive for several reasons: extrapolations fromDrosophila to Medflies are unjustified; the range of densities they studied is 2–120 times higher than that used in other studies; they ignore data on Medflies held in isolation, which rule out density effects; their own data suggest that initial cohort density has no effect on mortality rates at older ages, which is the relevant part of the life cycle; their experiment is too small to provide accurate estimates of mortality; new Medfly experiments executed at multiple densities show decelerating and then declining mortality rates at advanced ages for all densities. WhenDrosophila survivorship experiments are done on a sufficiently large scale they also show a deceleration of mortality at older ages that is not attributable to density effects. The deceleration of mortality rates is most likely a real facet of aging, and will have to be taken into consideration in any synthesis of the genetics and evolution of aging.     

Plasticity of death rates in stationary phase in Saccharomyces cerevisiae

For the species that have been most carefully studied, mortality rises with age and then plateaus or declines at advanced ages, except for yeast. Remarkably, mortality for yeast can rise, fall and rise again. In the present study we investigated (i) if this complicated shape could be modulated by environmental conditions by measuring mortality with different food media and temperature; (ii) if it is triggered by biological heterogeneity by measuring mortality in stationary phase in populations fractionated into subpopulations of young, virgin cells, and replicatively older, non-virgin cells. We also discussed the results of a staining method to measure viability instead of measuring the number of cells able to exit stationary phase and form a colony. We showed that different shapes of age-specific death rates were observed and that their appearance depended on the environmental conditions. Furthermore, biological heterogeneity explained the shapes of mortality with homogeneous populations of young, virgin cells exhibiting a simple shape of mortality in conditions under which more heterogeneous populations of older cells or unfractionated populations displayed complicated death rates. Finally, the staining method suggested that cells lost the capacity to exit stationary phase and to divide long before they died in stationary phase. These results explain a phenomenon that was puzzling because it appeared to reflect a radical departure from mortality patterns observed for other species.     

Trends in myeloma incidence,mortality and survival in New Zealand (1985–2016)

BackgroundMyeloma, one of the most common haematological malignancies worldwide arises in the bone marrow. Incidence rates vary by age and ethnicity but reasons behind these trends are unknown. Treatment of myeloma has changed significantly over recent decades, resulting in longer survival and decreased mortality.MethodsFrom data supplied by the Ministry of Health, all new registrations of and deaths from myeloma between 1985 and 2016 were extracted. Trends in age-specific rates were assessed using the method of Armitage. Age-standardised rates were calculated, and trends in age-adjusted rates analysed using the Mantel-Haenszel extension chi-square test. Age-adjusted incidence and mortality rate ratios were calculated. Myeloma-specific survival was visualised using Kaplan-Meier curves and multivariable hazard ratios calculated using Cox regression.ResultsBetween 1985 and 2016, 7826 New Zealanders were registered with myeloma. Over this time the age-specific incidence of myeloma increased significantly for men, who had higher rates than women. Myeloma mortality was highest in Maori men. Men had higher mortality rates than women in all time periods. Since 1995–1999, mortality has decreased in women whereas in men it has declined since about 2000–2004. Survival has increased significantly since 1990 but Maori still have a higher risk of death than non-Maori.ConclusionThe patterns of variation in myeloma incidence, mortality and survival, as well as their trends over time may be used to assist research into the causes and management of myeloma in New Zealand.     

Effect of density on age-specific mortality in Drosophila: a density supplementation experiment

Age-specific mortality rates were studied at two adult density levels in four inbred lines of Drosophila melanogaster. In experimental populations, adult densities were maintained at constant levels throughout the experiment by replacing dead flies with live, marked mutants. In control populations, densities declined naturally as the cohorts aged. For all experimental populations the best mortality model is the two-stage Gompertz model, with slower mortality acceleration at older ages. Flies in the experimental populations generally lived longer than flies in control populations, regardless of sex, genotype, or initial density level. The data demonstrate that deceleration of age-specific mortality rates at older ages is not caused by declining cohort densities. Mortality deceleration is a real phenomenon that raises serious questions about the evolution of senescence.     

Cancer mortality 1981–2016 and contribution of specific cancers to current socioeconomic inequalities in all cancer mortality: A population-based study

BackgroundIn many high-income countries cancer mortality rates have declined, however, socioeconomic inequalities in cancer mortality have widened over time with those in the most deprived areas bearing the greatest burden. Less is known about the contribution of specific cancers to inequalities in total cancer mortality.MethodsUsing high-quality routinely collected population and mortality records we examine long-term trends in cancer mortality rates in Scotland by age group, sex, and area deprivation. We use the decomposed slope and relative indices of inequality to identify the specific cancers that contribute most to absolute and relative inequalities, respectively, in total cancer mortality.ResultsCancer mortality rates fell by 24 % for males and 10 % for females over the last 35 years; declining across all age groups except females aged 75+ where rates rose by 14 %. Lung cancer remains the most common cause of cancer death. Mortality rates of lung cancer have more than halved for males since 1981, while rates among females have almost doubled over the same period.ConclusionCurrent relative inequalities in total cancer mortality are dominated by inequalities in lung cancer mortality, but with contributions from other cancer sites including liver, and head and neck (males); and breast (females), stomach and cervical (younger females). An understanding of which cancer sites contribute most to inequalities in total cancer mortality is crucial for improving cancer health and care, and for reducing preventable cancer deaths.     

Changes in Jewish mortality and survival, 1963–1987

Abstract

From information on mortality of Jews obtained from individual death certificates and population data from surveys of the Jewish population undertaken in 1963 and 1987, age‐specific death rates and life expectancy of the Jewish population of Rhode Island are compared with those of the total white population for 1963 and 1987 to assess changing differentials. The Jewish mortality experience continues to differ from that of the larger population even while both groups have experienced noticeable improvements. For males, the age standardized rates have widened in favor of Jews as have the life expectancies at birth and the percentage surviving to old age. By contrast, for females, the standardized death rate has widened considerably in favor of whites, while life expectancy has improved almost identically for both groups and therefore remained about equal, as it was in 1963. Reasons for these patterns are explored through attention to differences between Jews and the general white population in death rates at particular stages of the life cycle. Jews tend to be more advantaged at all but the most advanced ages, age groups in which proportionally more of the Jewish population and Jewish deaths are concentrated.     

Association between disparities in intergenerational economic mobility and cause-specific mortality among Black and White persons in the United States

BackgroundEvidence about the association between structural racism and mortality in the United States is limited. We examined the association between ongoing structural racism, measured as inequalities in adulthood income between White and Black children with similar parental household income (economic mobility gap) in a recent birth cohort, and Black-White disparities in death rates (mortality gap) overall and for major causes.MethodsSex-, race/ethnicity-, and county-specific data were used to examine sex-specific associations between economic mobility and mortality gaps for all causes combined, heart diseases, cerebrovascular diseases, chronic obstructive pulmonary disease (COPD), injury/violence, all malignant cancers, and 14 cancer types. Economic mobility data for 1978–1983 birth cohorts and death rates during 2011–2018 were obtained from the Opportunity Atlas and National Center for Health Statistics, respectively. Data from 471 counties were included in analyses of all-cause mortality at ages 30−39 years during 2011–2018 (corresponding to partially overlapping 1978–1983 birth cohorts); and from 1,572 and 1,248 counties in analyses of all-cause and cause-specific mortality in all ages combined, respectively.ResultsIn ages 30−39 years, a one percentile increase in the economic mobility gap was associated with a 6.8 % (95 % confidence interval 1.8 %–11.8 %) increase in the Black-White mortality gap among males and a 13.5 % (8.9 %–18.1 %) increase among females, based on data from 471 counties. In all ages combined, the corresponding percentages based on data from 1,572 counties were 10.2 % (7.2 %–13.2 %) among males and 14.8 % (11.4 %–18.2 %) among females, equivalent to an increase of 18.4 and 14.0 deaths per 100,000 in the mortality gap, respectively. Similarly, strong associations between economic mobility gap and mortality gap in all ages were found for major causes of death, notably for potentially preventable conditions, including COPD, injury/violence, and cancers of the lung, liver, and cervix.ConclusionsEconomic mobility gap conditional on parental income in a recent birth cohort as a marker of ongoing structural racism is strongly associated with Black-White disparities in all-cause mortality and mortality from several causes.     

Geographic distribution of hereditary myopathies in northeast Italy

Abstract

The conventional approach to the measurement of mortality conceptualizes mortality as a function of the age distribution of deaths. Because at contemporary mortality levels the great bulk of deaths are concentrated at the high ages, measures based on deaths are insensitive to mortality changes over most of the life span. An alternative is to conceptualize mortality as a function of the age distribution of death rates. When this is done, large differentials in mortality by sex and by race emerge from the data, calling attention to serious social issues that have been masked by conventional mortality indicators.     

Canadian Indian mortality during the 1980s

Abstract

This study concerns itself with an investigation of general and cause‐specific mortality differentials between Canadian Registered Indians (a subset of all aboriginals) and the larger Canadian population over two points in time, 1981 and 1991. Multivariate analyses are executed separately across four segments of the life cycle: adulthood, infancy, early childhood and late childhood. With respect to adults, Indians share relatively high rates of suicide, homicide and accidental causes of death; over time, their conditional risks of death due to cancer and circulatory afflictions have gone up significantly. Mortality disadvantages for the Indians are also pronounced in infancy, early childhood (ages 1–4) and late childhood (ages 5–14). Suicide, accidents, and violence constitute serious problems among 5–14 year olds, while infectious/parasitic, respiratory and circulatory complications, plus accidents and violence, are principle killers in infancy. For children aged 1–4, respiratory problems and accidents/violence are prime causes of premature death. This less‐than‐optimal mortality profile is reflective of persistent problems associated with prolonged socioeconomic marginalization. The temporal pattern of change in chronic/degenerative disease mortality among adult Indians suggests a movement of this population toward a mature stage of epidemiological transition.     

Mormon mortality rates in Canada

Abstract

In the United States, Mormons have been shown to have lower incidence and mortality rates of cancer and other diseases than the general population, a fact which has been attributed to the life style prescribed by the Mormon Church, including abstinence from tobacco, alcohol, coffee, and tea. This study examines Mormon cause‐specific mortality rates in Alberta, Canada, compared to rates for the general population of Alberta and of all Canada. Mormon death rates for most causes were lower than those for Alberta, which are themselves lower than Canadian rates. Mormon death rates for males were higher than for females for most causes, but male and female death rates were more similar among Mormons than in the general population. Causes of death for which Mormons have an average or higher than average risk are either less frequent causes or are less clearly related to dietary habits. Mormons have disproportionately low death rates for many causes which are not clearly related to the use of tobacco, alcohol, coffee, or tea. Further research is needed on the specific effects of different life‐style components and on the possible biological selectivity of the group.     

Trends in undernutrition mortality among children under five years of age and adults over 60

Introduction: Children under five years of age living in poor areas and with low availability of healthy food have a higher risk of undernutrition-related mortality. However, this relationship has not been well established among older adults.Objective: To analyse socioeconomic inequality trends related to undernutrition mortality in children under five years of age and adults over 60 in Colombian municipalities during 2003-2009 and 2010-2016.Materials and methods: We conducted an ecological study of trends between 2003 and 2016. The study population consisted of children under five years of age and adults over 60 residing in the Colombian municipalities during the study period. We estimated smoothed and standardized mortality rates by fitting a hierarchical Bayesian model and explored their relationship with five socioeconomic area-level variables.Results: In most of the municipalities, undernutrition-related mortality was three times higher in older adults compared to children. Moreover, the difference in the risk of undernutrition-related mortality between municipalities showed a marked reduction. Finally, the poor and less developed municipalities had higher rates of undernutrition-related mortality in children; conversely, wealthier territories had higher rates in older adults.Conclusions: Although in most of the municipalities the mortality rates due to undernutrition in children under five and older adults have decreased, their socioeconomic conditions influence in different ways the risk of mortality for these two populations so there is the need to develop age-specific strategies to close social gaps considering the structural conditions of the areas.     

Factores de riesgo asociados a fallecimiento por la variante ómicron de COVID-19: análisis retrospectivo con personas mayores de Canarias

Background and aimsSince the beginning of the COVID-19 pandemic, the elderly population has had the highest rates of complications and mortality. This study aimed to determine the influence of different risk factors on deaths due to the Omicron variant in the Canary Islands.Materials and methodsA retrospective observational study of 16,998 cases of COVID-19 over 40 years of age was conducted in the Canary Islands between August 1, 2022, and January 31, 2023. We extracted sociodemographic data (age and sex) and clinical data (death, vaccination history, hospital admission, previous diseases, and treatments).ResultsAmong the deaths, there was a higher proportion of males aged over 70 years, with diabetes, cardiovascular, renal, respiratory, and systemic diseases, and nursing home residents. Significant differences were observed in the number of doses of the vaccine. The multiple regression model showed that male sex (OR [95% CI] = 1.92 [1.42–2.58]), age (70–79 years, 9.11 [4.27–19.43]; 80–89 years, 21.72 [10.40–45.36]; 90–99 years, 66.24 [31.03–141.38]; 100 years or older, 69.22 [12.97–369.33]), being unvaccinated (6.96, [4.01–12.08]), or having the last dose administered at least 12 months before the diagnosis (2.38, [1.48–3.81]) were significantly associated with mortality.ConclusionsMultiple factors may increase the risk of mortality due to COVID-19 in the elderly population. In our study, we found that only three predictors can effectively explain the variability: older age, male sex, and not being vaccinated or last vaccination date prior to one year.     

Trend (1999–2009) in U.S. death rates from myelodysplastic syndromes: Utility of multiple causes of death in surveillance

BackgroundFor myelodysplastic syndromes (MDS) (formerly known as preleukemia), a diverse group of myeloid neoplasms usually involving anemia in elderly persons, trends in U.S. death rates apparently have not been reported.MethodsTrends in annual age-standardized rates per 100,000 from 1999 to 2009 were examined for MDS using multiple causes vs. underlying cause alone, coded on death certificates for U.S. residents.ResultsThe death rate (all ages combined) for MDS increased from 1999 to 2009, from 1.62 to 1.84 using underlying cause alone and from 2.89 to 3.27 using multiple causes. Rates using multiple causes were about 80% higher than those based on underlying cause alone. From 2001 to 2004 the rate for MDS using underlying cause alone (but not using multiple causes) declined, accompanied by an increase in the rate for deaths from leukemia as underlying cause with mention of MDS; this trend coincided with the advent of the 2001 World Health Organization's reclassification of certain MDS as leukemia. The MDS rate for age 65+ years increased after 2005, whereas the rate for age 25–64 years was low but declined from 2001 to 2003 and then stabilized. For deaths with MDS coded as other than underlying cause, rates did not decline for deaths from each of the two most common causes (i.e., cardiovascular diseases and leukemia).ConclusionsEvidence for decreases in MDS-related mortality rates was limited; the increase at age 65+ years is consistent with increases in incidence rates reported from cancer registries. Using multiple causes of death vs. only the underlying cause results in substantially higher MDS-related death rates, shows the impact of changes in the classification of myeloid neoplasms and emphasizes the importance of reducing cardiovascular disease mortality in MDS patients.     

A multistage theory of age-specific acceleration in human mortality

Background  

Humans die at an increasing rate until late in life, when mortality rates level off. The causes of the late-life mortality plateau have been debated extensively over the past few years. Here, I examine mortality patterns separately for each of the leading causes of death. The different causes of death show distinct mortality patterns, providing some clues about the varying acceleration of mortality at different ages.